Municipal community centers as healthy settings: evaluation of a real-world health promotion intervention in Jerusalem.

BACKGROUND: This study presents an intervention designed to foster the implementation of health promotion programs within District Municipality Community Centers (DMCCs) in Jerusalem, and the creation of a peer network of healthy settings with a shared aspiration of collaborating and implementing health-promoting policies at the community level. We also present the evaluation strategy, based on the EQUIHP and RE-AIM frameworks. METHODS: Twenty DMCCs completed our program. This evaluation research involved a comprehensive seminar during the first year for DMCCs coordinators, teaching them the principles of health promotion. An educational kit was distributed during the second year. The evaluation strategy included a process evaluation and annual evaluations based on the EQUIHP and RE-AIM frameworks. The EQUIHP tool was divided into four dimensions of evaluation: 1) Framework of health promotion principles, 2) Project development and implementation, 3) Project management, and 4) Sustainability; while the RE-AIM domains included: 1)Reach, 2)Effectiveness, 3)Adoption, 4)Implementation and 5)Maintenance. RESULTS: The program led to high responsiveness among DMCCs and to the implementation of diverse health promotion initiatives, with a participation of approximately 29,191 residents. The EQUIHP evaluation showed an improvement in program quality in Year 2. The final RE-AIM evaluation presented a total median score of 0.61 for all domains, where 0 was non-performance and 1.0 was full performance. The 'Framework of health promotion principles' and 'Reach' components received the highest median score (0.83, 1.0 and 0.87), while the 'Sustainability and 'Maintenance' components received the lowest (0.5). CONCLUSIONS: This innovative program adapts the Healthy Cities approach (initiated by the World Health Organization in 1986) to the development of community center health-promoting settings within the larger municipal framework, training local community center staff members to assess and address local health concerns and build community capacity. The local focus and efforts may help community actors to create health promotion programs more likely to be adopted, feasible in the 'real-world' and able to produce public health impact in the communities where people live. Moreover, collaboration and cooperation among DMCCs may lead to a broader community health vision, forging coalitions that can advocate more powerfully for health promotion. TRIAL REGISTRATION: NIH trial registration number: NCT04470960. Retrospectively registered on: 14/07/2020.

A decade of progress: comparative evaluation of the Israel Healthy Cities Network.

Established in 1990, Israel's Healthy Cities Network (HCN) performed its first evaluation in 2003-2004. A decade later, the present evaluation was implemented to assess members' compliance with the European HCN requirements and to determine progress made since the initial evaluation. A total of 31 of the existing 42 HCN members participated in this mixed methods evaluation. Based on the Monitoring, Accountability, Reporting, and Impact assessment framework, the evaluation questionnaire integrated Healthy Cities' principles and strategies. Univariate and bivariate analyses were used to investigate municipality performance as well as associations between indicators and structural or process measures. Matched-paired t-tests were performed to compare HCN member cities' initial evaluation with the current evaluation. Qualitative analyses explored the processes involved in implementing the Healthy Cities approach. The current evaluation found that Israel's HCN complies with all European HCN requirements, except for producing a city health profile. Increased coordinators' time investment, maintaining municipal health steering committee meetings and attending HCN activities were positively associated with better score on all dimensions. There was no significant difference between the two evaluation scores for all HCN cities collectively; however, within city comparisons indicated significant change. Coordinators reported that there was added value in HCN membership and conveyed a need for better network facilities, publicity and improved public relations. This evaluation validates the previous evaluation's findings and informs decision makers and municipal leaders regarding potential areas to modify or expand, both on the municipality level and the network at large.

Established in 1990, Israel's Healthy Cities Network (HCN) performed its first evaluation in 2003­2004. A decade later, the present evaluation was implemented to assess members' compliance with the European HCN requirements and to determine progress made since the initial evaluation. A total of 31 of the existing 42 HCN members participated in this evaluation. Based on the Monitoring, Accountability, Reporting, and Impact assessment framework, the evaluation questionnaire integrated Healthy Cities' principles and strategies, integrating both closed and open-ended questions. The current evaluation found that Israel's HCN complies with all European HCN requirements, except for producing a city health profile. Increased coordinators' time investment, maintaining municipal health steering committee meetings and attending HCN activities were positively associated with better performance on dimensions of equity policy and management. There was no significant difference between the two evaluation scores for all HCN cities collectively; however, within city comparisons indicated significant change. Coordinators reported that there was added value in HCN membership and conveyed a need for better network facilities, publicity and improved public relations. This evaluation validates the previous evaluation's findings and informs decision makers and municipal leaders regarding potential areas to modify or expand, both on the municipality level and the network at large.

Integration of Mixed Methods in Community-Based Participatory Research: Development of a Disease Prevention Intervention for Ultra-Orthodox Jewish Women.

PURPOSE: To describe the development of the first disease prevention intervention with ultra-Orthodox Jewish (UOJ) women in Israel using mixed methods and community-based participatory research (CBPR). DESIGN: This collaborative, 7-staged development process used an exploratory sequential mixed methods design integrated into a community-based participatory approach. SETTING: The UOJ community in Israel, a high-risk, low socioeconomic, culturally insular minority that practices strict adherence to religious standards, maintains determined seclusion from mainstream culture and preserves traditional practices including extreme modesty and separation between the sexes. PARTICIPANTS: Women from a targeted UOJ community in Israel with distinct geographic, religious, and cultural parameters. These included 5 key informant interviewees, 5 focus groups with 6 to 8 participants in each, a cluster randomized sample of 239 questionnaire respondents (an 87% response rate), and 11 steering committee participants. METHOD: Qualitative data were analyzed through Interpretative Phenomenological Analysis by 2 researchers. Quantitative data were collected via questionnaire (designed based on qualitative findings) and analyzed utilizing descriptive statistics. RESULTS: Barriers to health behavior engagement and intervention preferences were identified. The final intervention included walking programs, health newsletters, community leader trainings, teacher and student trainings, and health integration into schools. CONCLUSION: Utilizing mixed methods in CBPR improved cultural tailoring, potentially serving as a model for intervention design in other difficult to access, low socioeconomic, and culturally insular populations.